Urinalysis: Urine Tests Simplified

Urinalysis is a simple, easily accessible tool to evaluate your health.

Analyzing a simple urine sample provides quick insights into several health indicators, ranging from hydration status to more significant concerns, such as kidney function and metabolic processes. 

Let’s look at the essentials of urinalysis and what the results may indicate about your health.

What is urinalysis? 

Urinalysis is a powerful diagnostic tool that examines substances in the urine to provide a comprehensive picture of a person's overall health.

Historically called uroscopy, the first known use of urinalysis dates back 6000 years, when ancient physicians assessed the color, clarity, and other visual aspects of urine to evaluate health status.

Today, urinalysis continues to be an essential part of modern medicine and can detect various abnormalities. 

It can also be done at home to monitor specific biomarkers, such as ketone and glucose levels, which can help you track changes and overall progress related to diet or lifestyle changes.

Watch the video below for a comprehensive breakdown of how to understand urine test results.

Types of urine tests

A routine urinalysis includes a visual, chemical, and microscopic examination of a urine sample.

The visual exam evaluates aspects such as urinary color, clarity, smell, and consistency, while chemical analysis uses a dipstick to detect substances such as protein, glucose, ketones, and pH levels. 

The dipstick method utilizes a plastic strip with several chemically treated pads that change color in reaction to certain substances in urine. 

Each color represents the concentration of a substance, and the results are compared to a color chart to determine whether they are within a healthy range or indicate potential issues.

For a more detailed assessment, a microscopic urine exam can help detect cells, crystals, and bacteria that may not be visible to the naked eye or detected by a dipstick test.

What do urine tests measure?

Urine analysis is part of a routine medical exam and can reveal important details about various substances in your body. 

Urinalysis tests help identify potential health concerns and show insight into how lifestyle changes may affect your physiological functions. 

Common markers included in routine urinalysis include: 

• pH levels

• Protein

• Glucose

• Ketones

• Bilirubin

• Urobilinogen

• Nitrites

• Leukocyte esterase

• Crystals

• Specific gravity

What can urinalysis test results indicate?

Examining different substances in your urine can help you gather critical information about your body’s condition and spot potential issues early.

Here are some of the most common markers urine tests measure and what the results may indicate about your health.

Ketones

Ketones are substances produced by the liver during fat metabolism, a process known as ketogenesis. This process is triggered once the body has depleted its glucose reserves and uses body fat as an alternative energy source. 

Ketogenesis can be triggered by fasting, prolonged exercise, low-carb diets, or, in more concerning cases, when the body lacks sufficient insulin or cannot use it effectively, as often seen in uncontrolled diabetes.

Elevated ketone levels in a urine test can be a healthy indication that your body is effectively using fat as its primary energy source, particularly if you are following a low-carbohydrate diet, such as Healthy Keto®, or are practicing prolonged fasting. 

However, in individuals with diabetes, especially type 1 diabetes, excessive ketone levels can be a sign of diabetic ketoacidosis, a serious life-threatening condition that requires immediate medical attention.  

Protein

Protein is typically absent or present only in minimal amounts in urine, as kidneys filter proteins during blood purification. Elevated urinary protein levels may indicate damaged or impaired kidney function.

In addition, dehydration, pregnancy, acute or chronic inflammation, physical stress from intense exercise, fever, or exposure to extreme temperatures can also temporarily raise protein levels in urine.

Glucose

Glucose, the body's primary energy source, is usually reabsorbed by the kidneys during filtration and doesn’t typically appear in urine in significant amounts. 

High urinary glucose levels often indicate that the body isn’t producing enough insulin or cannot use it effectively, which is typically linked to metabolic imbalances such as diabetes.

"If you notice glucose in your urine, it may indicate that your blood sugar is critically elevated," explains Dr. Berg, "This could be a sign of prediabetes, diabetes, or other metabolic disorders, making early detection crucial for addressing these issues promptly and preventing them from worsening."

Glucose in urine may also indicate gestational diabetes in pregnant women, as well as indicate hormonal disorders or the effects of certain medications.

pH levels

pH levels reflect the urine's acidity or alkalinity, which can vary with diet, hydration status, and underlying health issues.

The pH scale ranges from 1 to 14, with lower values representing acidity and higher values indicating the degree of alkalinity. Healthy urine is slightly acidic and should have a pH between 5 and 6.

A high urine pH can be caused by an excessive intake of alkaline foods or beverages, bacterial infections, kidney issues, gout, vomiting, and diuretics. 

In contrast, low urinary pH may be linked to high protein consumption, uncontrolled diabetes, diabetic ketoacidosis, prolonged fasting, dehydration, or diarrhea. 

Research published in the Journal of Nephrology found that urinary pH is a significant predictor for kidney stone formation. The authors conclude, "An alkaline pH favors the crystallization of calcium and phosphate-containing stones, whereas an acidic urine pH promotes uric acid or cystine stones."

Bilirubin

Bilirubin, released during the breakdown of red blood cells, is metabolized in the liver and excreted through bile and stool.

When found in urine, bilirubin can indicate the liver is struggling to manage waste products, potentially signaling issues such as hepatitis, bile duct obstruction, or gastrointestinal infection.

Less severe causes of urinary bilirubin can include testing shortly after a large meal, alcohol consumption, vigorous exercise, certain medications, or consumption of specific foods such as beets or blueberries.

Urobilinogen

Urine typically contains only trace amounts of urobilinogen, which is a metabolic by-product formed when intestinal bacteria break down bilirubin.

High levels of urinary urobilinogen can suggest liver disease, hemolytic anemia, or cirrhosis, while low levels may be linked to potential bile duct obstruction, hydration status, and certain prescription medications.

Nitrites

Urine tests measure nitrites to indicate bacterial presence as certain bacteria that cause urinary tract infections (UTIs), such as Escherichia coli (E. coli), naturally produce nitrites.

While nitrites generally suggest a bacterial infection, they can also result from diet or the presence of potentially beneficial bacteria. 

Historically, healthy urine was believed to be sterile, but research published in European Urology has found that, especially for women, this may not be the case.

The study revealed that the female bladder naturally contains its own microbiota, which “may contribute to urinary health and disease in undiscovered ways.”

This finding suggests that traditional infection detection methods might need to be revised to distinguish between potentially harmful pathogens and the natural microbiota.

This also highlights the importance of further testing after urinalysis to eliminate false positives and identify potential imbalances within the urinary tract microbiome.

Leukocyte esterase

Leukocyte esterase is an enzyme released by white blood cells, and its presence in urine often indicates infection or inflammation in the urinary tract. 

While leukocyte esterase in a urine specimen can suggest an infection, it may also result from vaginal secretion contamination, kidney stones, exercise, or inflammation.

Crystals

Urine can contain crystals, which are tiny particles consisting of minerals or salts. 

While a few crystals are often harmless, certain types, such as calcium oxalate, uric acid, or phosphate crystals, could point to kidney stones, liver disease, UTIs, or gout.

Specific gravity

A urine-specific gravity test measures the concentration of solutes in urine, providing valuable information about the kidney's ability to concentrate or dilute urine.

High specific gravity is a sign of concentrated urine and may be related to dehydration, while low levels can indicate excessive fluids or kidney issues.

How to take a home urinalysis test

Using a home urinalysis kit is an easy and convenient strategy to monitor your health regularly. 

Most kits on the market evaluate between 10 to 14 health markers, although specific tests are also available to measure ketones, glucose, or pH levels.

Before testing, it’s crucial to conduct thorough research on the urinalysis kit you plan to use, as their accuracy can vary significantly between different brands.

A  study published in Biochemia Medica underscored this issue, stating, “Unfortunately, urine dipstick testing suffers from substantial variability among manufacturers relative to their sensitivity, specificity, and measurement range.”

Once you've chosen a reliable brand, collecting a clean-catch urine sample for accurate results is essential. This involves carefully cleaning the genital area before collection to minimize the risk of contamination.

After cleansing, the sample can be collected. Simply urinate into a sterile collection cup until you have enough to submerge all the pads on the urine dipstick. 

Dip the test strip, saturate all pads, promptly remove it, and wait as instructed. The dipstick will eventually change color to reflect the substance levels, which can then be compared to the provided chart.

When to see a doctor

If your tests show extreme or persistent abnormal results, it may indicate an underlying health condition that requires medical evaluation.

It’s critical to take abnormal urinalysis test results seriously, even if you feel healthy, as they may indicate underlying health issues that could require prompt attention. 

In addition, you should consult a healthcare provider if you experience symptoms such as:

• Frequent or painful urination

• Blood in urine

• Severe back pain or abdominal pain 

• Unexplained weight loss or fatigue

• Changes in urine color, smell, or consistency

• Swelling in hands, feet, or face

These symptoms could be signs of various conditions, including UTIs, kidney stones, diabetes, or other serious health issues. 

Key takeaways

Urinalysis is a valuable diagnostic tool that analyzes urine to measure health and can detect a range of potential conditions, from dehydration and UTIs to kidney disease and diabetes.

It also offers an excellent, non-invasive way to monitor biomarkers such as glucose and ketones, helping you stay informed about the impact of lifestyle changes, such as diet and exercise.

Regular monitoring with urinalysis can reveal potential issues early, enabling proactive steps for health maintenance.

FAQ

1. What does a urinalysis test show?

Urinalysis can reveal information about kidney function and urinary tract infections and typically evaluates health markers, including pH levels, protein, glucose, ketones, red blood cells, leukocyte esterase, nitrite, bilirubin, and urobilinogen. 

2. What is a bad urinalysis result?

Red blood cells, elevated protein or glucose levels, or the presence of bacteria in urine may indicate potential health concerns and typically require further evaluation by a healthcare provider.

3. What indicates a UTI in a urinalysis?

Leukocyte esterase, nitrites, and white blood cells in the urine often indicate a urinary tract infection.

4. Are urine tests accurate?

Urine tests are generally accurate and helpful in identifying potential health issues. However, accuracy can vary by brand, and further testing is recommended to confirm a diagnosis or determine the exact nature of a condition.

5. How long does a urinalysis test take?

While a laboratory urinalysis, typically conducted as part of a routine medical exam, may take a few days, at-home test kits offer results within minutes.

Sources

1. https://pubmed.ncbi.nlm.nih.gov/21170875/ 

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4659483/ 

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366948/